Nintendo Wii Balance Board therapy for postural control in children with cerebral palsy: a systematic review and meta-analysis

Aim To analyse the efficacy of Nintendo Wii therapy (NWT) on functional balance in children with cerebral palsy (CP). Method A systematic review with meta-analysis (PROSPERO identification number CRD42020169510) was performed using randomized controlled trials (RCTs) that examined the effect of NWT on functional, dynamic, and static balance in children with CP, assessed with the Pediatric Balance Scale, the Timed Get Up and Go Test, and the One Leg Stance Test respectively. The pooled effect was calculated using the Cohen's standardized mean difference (SMD). Results Eleven RCTs with 270 children (when sex was reported: 43% females, 57% males) with CP (mean age [SD] 10y 1mo [1y 1mo], range 5-16y) were included. On functional balance, we found very low-quality evidence with a large effect of NWT compared with no intervention (SMD 0.95, 95% confidence interval [CI] 0.02-1.89) and moderate-quality evidence for using NWT plus conventional physical therapy (CPT) versus CPT (SMD 0.78, 95% CI 0.20-1.35) in sessions of approximately 30 minutes (SMD 0.86, 95% CI 0.20-1.52) and interventions lasting longer than 3 weeks (SMD 1.03, 95% CI 0.58-1.47). For dynamic balance, very low-quality evidence for a medium effect for using NWT plus CPT versus CPT (SMD 0.70, 95% CI 0.12-1.29) was found. Interpretation NWT can be considered an effective treatment for improving functional and dynamic balance in children with CP, especially when combined with CPT in 30-minute sessions with interventions lasting longer than 3 weeks.